基于单中心的胃混合性腺神经内分泌癌临床病理特征及预后分析

Clinical characteristics and prognostic analysis of patients with gastric mixed adenoneuroendocrine carcinoma based on single clinical center

目的:探讨胃混合性腺神经内分泌癌(mixed adenoneuroendocrine carcinoma,MANEC)患者的临床表现、病理特征及预后。方法:对复旦大学附属中山医院2014年11月至2015年12月收治的14例MANEC患者的临床病理资料和随访资料进行回顾性分析。结果:14例胃MANEC患者中,男性13例,女性1例;病灶位于近端8例,远端6例;胃大弯4例,胃小弯10例;血清肿瘤指标癌胚抗原(CEA)升高6例,糖类抗原19-9(CA19-9)升高3例。所有患者神经内分泌癌成分均为G3级;伴有癌栓9例,神经束侵犯11例;淋巴结转移阳性9例,转移成分为单纯神经内分泌癌3例,单纯腺癌2例,2种成分皆有4例。肿瘤TNM分期为Ⅲ期9例,Ⅱ期5例。腺癌成分中HER-2阴性12例,c-MET阳性11例。所有患者均接受根治性手术治疗,7例进行辅助性化疗。所有患者中位随访时间为24个月,随访期间6例患者病情进展,6例患者死亡。结论:胃MANEC发病率相对较低,临床表现无特异性,但癌细胞周围侵袭性明显,恶性程度高,预后差。

Objective：To investigate the clinical manifestations, pathological characteristics, and prognostic factors of patients with gastric mixed adenoneuroendocrine carcinoma （MANEC）. Methods：The clinicopathological and follow-up data of 14 patients with gastric MANEC who were admitted to Zhongshan Hospital, Fudan University from November 2014 to December 2015 were analyzed retrospectively. Results：Among the 14 gastric MANEC patients, there were 13 males and 1 female. For eight cases, the lesions were located in the proximal stomach, and for 6 cases the lesions were in the distal stomach. Serum tumor marker CEA was elevated in 6 cases, and CA19-9 in 3 cases. The neuroendocrine carcinoma in all patients was G3. Nine cases had tumor thrombus, 11 cases had neural invasion. Nine cases had lymph node involvement, of which 3 cases had pure neuroendocrine carcinoma metastasis, 2 cases had pure adenocarcinoma metastasis, and 4 cases had both components. Twelve cases had HER-2 negative adenocarcinoma and 11 cases had c-MET positive expression. All patients underwent surgery, and 7 cases received adjuvant chemotherapy. The median follow-up time of all patients was 24 months. At the end of the follow-up, 6 patients’condition further developed and 6 patients died. Conclusions：The incidence rate of gastric MANEC is relatively low. Most of the patients with gastric MANEC have nonspecific symptoms. With the highly invasive ability, the degree of malignancy is high and the prognosis is poor.